Not long ago I met Tucker, a ten-year-old Labrador Retriever. Tucker is simultaneously one of the unluckiest and luckiest dogs on earth. He is unlucky because he has suffered through bloat, one of the worst things that can happen to a dog. Twice. He is lucky because he survived it both times.

There are three kinds of bloat in dogs, all of which refer to severe distension of the stomach.

Food bloat occurs when a dog (usually a Beagle or Lab) breaks into a large stash of food and eats as much as he can — which is a lot. The dog soon suffers glutton's remorse, manifested by a distended abdomen, lethargy, and a feeling that must be similar to Thanksgiving Day times ten. Most dogs with food bloat recover after a day or two of digestion (although they often benefit from intravenous fluids to help the process).

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Dogs who eat too much human food can risk getting bloat.

Bloat without torsion occurs when the stomach's sphincters (valves) don't move contents through in a normal fashion. The stomach swells, but does not twist. The abdomen distends and the dog feels pain, but the bloating usually is non-life-threatening (unless it leads to gastric torsion — see below).

Finally, there is the real deal bloat, also known as gastric dilatation with volvulus, or GDV. In this scenario the stomach becomes distended (and owners should be aware that both of the more mild forms can predispose dogs to GDV) and then twists in the abdomen. In some cases it twists and then distends.

The causes are not fully understood. Gastric distention can trigger it, as can foreign bodies in the stomach. Stress is a risk factor, possibly because it causes dogs to swallow air. Old age, large size, and deep-chested body types are risk factors, probably because of strain and weakening of ligaments that hold the stomach in place. However, GDV (hereafter referred to as bloat) has been documented in almost every breed and age category .

Although the causes aren't fully understood, many of the consequences are. The dog's enlarged stomach causes severe pain and nausea. The abdomen becomes markedly distended, and dogs with bloat often try but are unable to vomit. Blood flow to the stomach and spleen are compromised, and portions of both organs may die. Blood flow through the caudal vena cava, one of the largest and most important vessels in the body, is compromised. Shock and death can occur within hours.

Bloat is one of the most urgent emergencies a dog can suffer. Treatment involves passing a stomach tube to reduce distention of the stomach. Emergency surgery should then be performed to assess the damage, correct the position of the stomach, and tack the stomach in place to prevent the problem from happening again.

All of this brings us to Tucker. Three years ago he bloated. His owners caught it quickly, and he underwent surgery and survived. The surgeon who operated made sure to affix the stomach to the body wall in order to prevent the stomach from twisting again.

Therefore, when Tucker came to my office with a painful, distended abdomen I expected him to have one of the more benign forms of bloat. I was deeply saddened by his X-rays. They showed that the stomach had torsed a second time. I called a surgeon, who was incredulous. All vets know that dogs can in theory bloat again after a first surgery. However, it almost never happens. Almost is the key word. It was determined during surgery that the initial surgical tack despite being properly performed, had failed in two places.

It was rough for several days, but Tucker recovered. The second surgeon took care to tack the stomach to the body wall in two places, rather than one. Tucker would need to be extremely unlucky, even by his own standards, to suffer a third bloat.